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Wednesday, January 21, 2009

Prevention, punishment, mental illness and crime

The US Supreme Court has said executing the mentally retarded is unconstitutional, but the mentally ill are still fair game. Dr. Lucy Puryear, a clinical psychiatrist from the Baylor College of Medicine offers a thoughtful discussion at Women in Crime Ink regarding the astonishing case of Andre Thomas, a schizophrenic death row inmate who plucked out his only good eye and ate it (he'd pulled the first one out while sitting in jail awaiting his capital murder trial), adding a whole new dimension to the biblical adage, "an eye for an eye."

In 2004 Andre Thomas killed his wife and children, cut their hearts out, put the hearts in his pocket, and walked outside. He then went home, put them in a plastic bag and threw them out. He stabbed himself three times in the chest and then walked into a police station to report his crime.

But while most of the public debate about Thomas revolves around whether he should be executed for his crime, Dr. Puryear offers a more constructive reaction, wondering how his crime might have been prevented in the first place:

To those of you who would suggest that I am soft on crime, consider this novel idea. How about we make mental health treatment available in the community to those who need it. Had Mr. Thomas been adequately treated and monitored he never would have killed his family or plucked out his eye. Three people would be alive today and an enormous amount of money would be saved keeping him out of the prison system. That's not soft on crime, that's preventing crime.

Excellent point! Given that Andre Thomas had twice sought psychiatric help at a local hospital in the weeks before he murdered his family, these observations are particularly salient. In the comments section she added:

I am not suggesting that being mentally ill is a get out of jail free card.

I am saying that the system is broken. That people with severe mental illnesses often do not receive adequate care in the community. It can take three months or longer to get an outpatient appointment in our "free" (paid for by taxpayers)mental health system in Harris County. While waiting for these appointments people go off of their medications, become ill, and SOME commit crimes.

There may be one way to make some sense out of the issue of the mentally ill who commit crimes. Several communities have Mental Health Courts. These courts are in place for those defendants who have histories of mental illness before committing a crime, or committed a crime while mentally ill. The lawyers, judges, and others assigned to these courts have special training in mental illness and are equipped to knowledgeably handle these defendants. Instead of the revolving door from prison to back on the streets where psychiatric care is lacking, then back in prison when another crime is committed, these persons can be put into a system where follow-up is mandatory and resources are available. Another example of not being soft on crime, but preventing crime.

And in the comments, the good doctor mentioned a common sense solution for mentally ill offenders who go off their meds:

When I worked briefly in Ohio we could get outpatient commitments that meant that a patient was mandated to attend outpatient appointments. If they did not show they could be picked up and returned to an inpatient facility.

Dr. Puryear's post reminds us that by the time mentally ill people commit heinous crimes, we're having the discussion too late.

I really admire Lucy's professionalism and her common sense reaction to this sad, heinous case. While most of us, myself included, can do little but gape in awe at such a monstrous crime, her writing demonstrates an ability to perceive the thread of humanity underlying Thomas' illness and recognize that, even though a horribly tragedy occurred, the outcome wasn't inevitable. If society learns the right lessons, maybe more such horrific cases can be prevented in the future.

13 comments:

jsn
said...

Our state mental hospitals have one inpatient bed for every 15,000 residents where the national average appears to be about one bed for every 4,500 residents. On occasion a person that was refused admission because all inpatient beds were filled commits suicide and nobody seems to notice.

If a mentally ill person needs 24 x 7 supervision and no inpatient beds are open they are very likely to be arrested and held in jail. Now the CJ system is involved and if the jail has a mental health diversion program or the county has a drug-mental health court it may be possible to get them stabilized to the point where they can be released. If not they can spend a long time in jail (in particular if they will not cooperate with their defense attorney).

In some communities jail diversion and drug-MH courts have public and CJ system support and in other communities they are not so sure they are a good idea and maybe jail is not such a bad alternative.

Is it a just outcome when someone spends a month in jail for being a pain the rear in a public place?

I agree with everything said except the assertion that "going off meds" is the cause of the problem. Often people commit these crimes while on their meds. People just assume they must have been "off their meds". The fact is that often these medications just don't work.

8:57 - the flip side is that the medications used for bipolar disorder and schizophrenia have side effects that tend to make people to stop taking them. The so-called "new generation" antipsychotics are better, but it's still a big problem.

Excellent post! I work with mentally ill offenders in a maximum security prison, and I could not agree more with what the doctor says. Our system is so badly broken.

As for the comment by anonymous ... the problem with the meds "not working" is that the nature of several of these illnesses, especially schizophrenia, is that something that may work for a while needs adjustment or a change, and the disease is very much influenced by situational factors and stressors. Constant, constant monitoring is necessary.

Or Mental Health System was broken by our government, right here in Texas.

I recall the days when State Hospitals were closed and people either sent to nursing homes, or just turned out into the streets.

Yes, people our dear State government did this to save money!! Save money this did not do!! Now, those who are mentally ill are imprisioned, without any care and treated worse than one would treat a mad bull or an animal who would be trying to attack you.

We need to wake our Legeislators up and tell them, "You were elected by us and we expect you to support our needs and not those of some wealthy individual or company who tends to pay you either out right or under the table!"

We need to take care of our own and stop sending everyone to prison. If you have never seen a psychotic episode, then you may have no idea from whence some of you write. Mental illness is horrible and comes in varying degrees, lets take care of these ill people, not further the diseas process by imprisioning them.

There will always be a few cases that treatment will not fix, people who are broken beyond repair for whom strict incarceration is the only possibility. But we'll never know which ones those are until we have a system that actually tries to fix them first.

Until enough politicians are willing to realize and put forth legislation that is "smart" on crime instead of just being "tough" on crime, we will continue to have serious problems. Unfortunately, many Texans like to talk the "New Testament" talk, but walk the "Old Testament" walk.

A big part of the problem with the mentally ill is that the Justice System has done far such a good job of making mentally ill "offenders" voiceless and faceless.

The system was not so successful making Andrea Yeats disappear and therefore her outcome was better than the vast majority of mental illness cases.

Thanks to Grits and others for doing their very best to give a voice and face to the mentally ill in prison. Improvements in the judicial and mental health systems are desperately required to fairly provide for the truly needy in our society.

These changes will only come with visibility of the fact that we can do better.

I need an education. What percentage of mentally ill Texans need to be committed to a mental hospital for long term? How many need to be in out patient care? How many mentally ill inmates in TDCJ never get any treatment? How many have been diagnosed with borderline PD, Anti-social personality, ADD/ADHD, with learning disabilities. borderline intellectual functioning and social/family problems axis etc.. as opposed to those with paranoid schitzophrenia, bipolar disorder and other severe mental illnesses like Andre's. I'm not discounting the others, I mean functioning vs. non functioning. We tend to diagnose everyone with mental disorders these days. In the DSM there is a diagnosis for just about everything. I believe we've overdone it. What on earth did we do we do before ADHD? I say we did better. People taught their children to cope, adjust, channel energy, learn discipline with out meds and a diagnosis. Now that being said, let me make it clear that I am not saying mental illness doesn't exhist, I just think that term is applied very liberally, so much though that sick people could easily get lost in the system.I also wasn't aware that there was no mental health treatment at TDCj. I believe a former supervisor of mine worked in Huntsville in Psych services as an intervention specialist. She quelled riots and managed crisis. She worked all over TDCJ doing this kind of work, even after the big rifts. I know there are services. Maybe not ideal, but more than what I can afford right now. How do we decide who is more deserving of it, or more likely to go off. I think many of you love the mentally ill but not the individual. You all are terribly compassionate when it come to psychotic, schyzophrenic inmates you believe could have been helped if only they had been identified before. That sounds so noble after the fact. I imagine this great compassion and brotherly love disipates the closer it is to home. We don't feel so much love and compassion for ailing coworkers, who seem obviously distressed and or disturbed. Mentally ill coworkers get mistreated by other coworkers. They get ignored, tormented and targeted. Some fade away, some fight back, some go off. Thankfully not many go off. How many of you are willing to give your time, money and hands on to help out? Start by looking at those around you. Maybe you will be a savior. Look in the mirror for the change you seek. We are in the protherapy cycle and there never seems to be middle ground, only ditch drivng. Why not try the middle of the road for a change.

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